RN Medical Necessity Reviewer

Integrated Resources Inc.; Des Moines (IA); On-site; USD 70,000 - 90,000; Full time

Job summary

A staffing firm in Iowa seeks a Clinical Care Reviewer to perform medical necessity reviews. The role involves using clinical knowledge to assess service requests, with a focus on ensuring quality care and compliance with organizational guidelines. Ideal candidates will have extensive nursing experience and a valid Iowa RN license.

Qualifications

• Registered Nurse with 3-5 years experience in a related clinical setting.
• Valid Driver's License and reliable transportation.

Responsibilities

• Conduct thorough medical necessity reviews for inpatient and outpatient services.
• Work closely with members and providers to gather necessary information.
• Apply medical health benefit policy and medical management guidelines.

Skills

Excellent oral and written communication skills

Ability to identify problems and recommend solutions

Self-directed

Excellent time management

Advocacy for member needs

Education

Registered Nurse graduated from an accredited program

Current unrestricted Iowa Registered Nurse license

Job description

A staffing firm in Iowa seeks a Clinical Care Reviewer to perform medical necessity reviews. The role involves using clinical knowledge to assess service requests, with a focus on ensuring quality care and compliance with organizational guidelines. Ideal candidates will have extensive nursing experience and a valid Iowa RN license.